Reduction of User Fees in the Private-Not-For-Profit Hospitals in Uganda: Implications for Equity and Sustainability

Abstract

While the reduction of user fees was not seriously contested as a big step towards equity and evidence of faithfulness to their mission, many private-not-for-profit (PNFP) hospitals dragged their feet in implementing these reductions, especially where the fees constituted a big proportion of their income. There were fears of diminishing revenue from fees, increasing expenditure on drugs and sundries, unreliability of government funding, fluctuation of income from other unreliable sources and serious threats to sustainability. With empirical evidence from 4 PNFP hospitals, this article demonstrates that where fees constituted a barrier to access, there is likelihood for the overall revenue from fees to increase after their reduction because of increased patient numbers. It will also be shown that recurrent expenditure on consumables may not increase above the level of revenue from fees where there is prudent management. Henceforth, it will be argued that reduction of user fees does not compromise financial sustainability and health equity but rather promotes them both.